Incontinence is a prevalent condition that contributes to the high morbidity and health care costs of nursing home populations as well as to the high workload and frequent turnover of nursing home staff. The proposed research is designed to examine the cultural, social, organizational, and clinical aspects of continence care for older adult residents and staff in nursing homes. The aims of this 3-phase ethnographic study are to: 1) describe how continence care practices of residents and staff contribute to incontinence in nursing homes, 2) understand the positive continence responses and strategies used to resist oppression, and 3) describe the interplay of marginalized status, ritual and symbolism, power and oppression, and continence beliefs and practices. Nursing home residents, direct care staff, and administrative/professional staff of four nursing homes will comprise the study's participants and setting. Participant observation, unstructured conversations with staff and residents, archival records, documents and artifacts will provide a description of continence care activities. Guided interviews with key informants will offer a further understanding of continence care behaviors and beliefs. Critical analysis to determine how underlying symbolic interpretations and power issues contribute to the high prevalence of incontinence in nursing homes will be conducted. The findings of this study will be used to develop a middle-range theory of continence care in nursing homes and provide the basis for later nursing interventions research.